Health Contingent Wellness Program

HEALTH CONTINGENT WELLNESS PROGRAM

The Preventive PLUS HX Solutions Health Contingent Wellness Program is a member-centered strategy that promotes member and physician engagement.

Member engagement, along with health literacy, is the most effective and efficient strategy to slow down the natural progression of disease. The Identification and management of health risks and disease are the best methods to enhance health and slow the growth of rising health care costs.

About Health Contingent Wellness Program

The Hx Benefit Design structure was carefully designed to be compliant with Part 146 Requirements for the Group Health Insurance Market with the Final Rule Incentives for Nondiscriminatory Wellness Programs in Group Health Plans by the Internal Revenue Service, the Employee Benefits Security Administration, and the Health and Human Services Department on 06/03/2013 146.121 Prohibiting discrimination against participants and beneficiaries based on a health status-related factors. The Regulations increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 percent to 30 percent of the cost of coverage. The regulations would further increase the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use.

The HX Solutions Health Contingent Wellness Program requires an individual to satisfy a standard related to a health factor to obtain a reward (or require an individual to do more than a similarly situated individual based on a health factor in order to obtain the same reward).

Health Contingent Wellness Program Features

The HX Solutions Health Contingent Wellness Program permits group health plans and group health insurance issuers to institute premium discounts or rebates or modification to otherwise applicable cost sharing (including co-payments, deductibles or coinsurance) in return for adherence to certain programs of disease prevention and health promotion and the ability to vary the cost sharing of the health benefits plan, with its members, based on each individual members participation and compliance with their respective physician directed treatment plan and determined milestones. This Disease Prevention and Health Promotion and strategy will result in a sustainable health care solutions, creating a healthier, happier, and more productive group, while at the same time, reducing health care costs for the plan sponsor as a whole.

Application to Grandfathered Plans

Section 1251 of the Affordable Care Act provides that certain amendments made by the Affordable Care Act generally do not apply to plans or health insurance coverage that are in effect on the date of enactment (and that are not changed in ways specified in implementing regulations),except as specified in section 1251(a)(3) and (4) of the Affordable Care Act. Specifically, section 1251(a)(2) of the Affordable Care Act provides that subtitles A and C of title I of the Affordable Care Act, and the amendments made by such subtitles, ``shall not apply'' to such grandfathered health plans.